II. Epidemiology
- Traumatic Carotid Dissections are rare, but potentially devastating
- Traumatic Carotid Dissections are most common in children
- Children (esp. age <6 years old) account for 73% of Traumatic Carotid Dissections
- However occur in only 0.03% Pediatric Trauma patients
III. Pathophysiology
- Predisposing factors in adults
- Carotid Atherosclerosis increases risk of carotid dissection with direct Trauma
- Predisposing factors in children (higher risk than adults)
- Intimal tear risk at ICA as it enters skull base at carotid canal
- Children at risk for carotid overstretching due to excessive neck hyperextension and rotation
- Large head to body ratio,
- Cranial cervical instability (weak neck Muscles, ligamentous instability risk)
IV. Background
- Blunt neck injury may result in occult and initially masked major neck vascular injury
- Risk of Carotid Artery Dissection and thrombosis
- May be initially asymptomatic with subsequent vessel thrombosis and hemispheric stroke within 72 hours
- Children are particularly high risk for missed injury (asymptomatic without initial neurologic signs)